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Factors Associated with Lumbar Puncture Performance in Zambia

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  • 1 Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland;
  • | 2 Department of Internal Medicine, University Teaching Hospitals–Adult Hospital, Lusaka, Zambia;
  • | 3 Department of Neurology, University of Michigan, Ann Arbor, Michigan;
  • | 4 Department of Child Neurology, University of Rochester, Rochester, New York;
  • | 5 Department of Neurology, University of Rochester, Rochester, New York;
  • | 6 University Teaching Hospitals–Children’s Hospital, Lusaka, Zambia;
  • | 7 Department of Neurology, Harvard Beth Israel Deaconess Medical Center, Boston, Massachusetts;
  • | 8 Centre for Infectious Disease Research Zambia, Lusaka, Zambia

ABSTRACT.

In much of sub-Saharan Africa, lumbar punctures (LPs) are performed less frequently than indicated. This is often attributed to patient/family refusal; however, other factors have not been systematically evaluated. We investigated predictors of LP performance for a prospective cohort of people with HIV and new-onset seizures at three hospitals in Zambia. We enrolled 257 participants, including 184 (72%) adults and 144 (56%) urban participants. LPs were performed for 65% of adults and 33% of children, and for 69% of urban and 38% of rural participants. In multivariate logistic regression analyses, LP completion was significantly less likely at one rural site and among children compared to adults. The worst WHO HIV disease stage was associated with increased odds of undergoing LP. Low LP completion rates in Zambia are multifactorial and related to health system and provider factors and patient/family preferences. Further research is necessary to understand this complex problem and develop interventions to improve LP uptake.

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Author Notes

Address correspondence to Gretchen L. Birbeck, Department of Neurology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642. E-mail: gretchen_birbeck@urmc.rochester.edu

Financial support: Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health (award numbers R01NS094037 and R01NS094037-S1). The content is solely the responsibility of the authors and does not necessarily represent the official views of the US National Institute of Health.

Authors’ addresses: Deanna Saylor, Johns Hopkins University School of Medicine, Baltimore, MD, and University Teaching Hospital, Lusaka, Zambia, E-mail: deanna@jhmi.edu. Melissa Elafros, University of Michigan School of Medicine, Ann Arbor, MI, E-mail: elafrome@med.umich.edu. David Bearden, Ifunanya Dallah, and Gretchen L. Birbeck, University of Rochester Medical Center, Rochester, NY, E-mails: david_bearden@urmc.rochester.edu, ifunanya.dallah@chet.rochester.edu, and gretchen_birbeck@urmc.rochester.edu. Manoj Mathews and Musaku Mwenechanya, University Teaching Hospital–Children’s Hospital, Lusaka, Zambia, E-mails: m_s_mathew@yahoo.com and mmusaku@gmail.com. Omar K. Siddiqi, Beth Israel Deaconess Medical Center, Boston, MA, and University Teaching Hospital, Lusaka, Zambia, E-mail: osiddiqi@bidmc.harvard.edu. Izukanji Sikazwe, Centre for Infectious Disease Research Zambia, Lusaka, Zambia, E-mail: izukanji.sikazwe@cidrz.org.

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